Is it time to re-evaluate the routines about stopping/keeping platelet inhibitors in conjunction to ambulatory surgery?

ABSTRACT

PURPOSE OF REVIEW To assess the influence of antiplatelet drugs (APDs) in outpatients' perioperative care and to propose up-to-date management of those patients. RECENT FINDINGS: Evidence is spreading on the risk of adverse cardiovascular events (ACEs) when APD therapy is discontinued, specifically in patients with coronary stents. Conversely, maintaining such treatments throughout the operative period appears usually safe. Bridging with low-molecular-weight heparins poorly protects against ACEs. In outpatients, major surgical bleeding is rare, but sometimes a minor hemorrhage may jeopardize the success of a surgical procedure. Despite the paucity of properly sized randomized trials in this setting, recommendations have been issued by scientific societies and can be used as guidelines. Variability in APD efficiency is now better appraised, and research on versatile bedside testing of platelet function is active. New drugs are expected to be launched in the near future, all this aiming at improving individualized drug dosage and therefore both safety and efficiency of APD therapies. SUMMARY: In surgical patients APD therapy should be maintained in all situations in which the risk of surgical bleeding is low, which is usually the case in the ambulatory setting. In clearly identified cases in which bleeding might threaten either the patient's life or the success of the surgical procedure in patients at high risk of ACE, the discontinuation protocol must be established in conjunction with the cardiologist and the APD therapy resumed as soon as possible. Bridging with low-molecular-weight heparins is not recommended.